Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7–9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.Deceased     

Parenting and Family Stress Treatment Outcomes in Attention Deficit Hyperactivity Disorder (ADHD): An Empirical Analysis in the MTA Study

Parenting and family stress treatment outcomes in the MTA study were examined. Male and female (579), 7–9-year-old children with combined type Attention Deficit Hyperactivity Disorder (ADHD), were recruited at six sites around the United States and Canada, and randomly assigned to one of four groups: intensive, multi-faceted behavior therapy program alone (Beh); carefully titrated and monitored medication management strategy alone (MedMgt); a well-integrated combination of the two (Comb); or a community comparison group (CC). Treatment occurred over 14 months, and assessments were taken at baseline, 3, 9, and 14 months. Parenting behavior and family stress were assessed using parent-report and child-report inventories. Results showed that Beh alone, MedMgt alone, and Comb produced significantly greater decreases in a parent-rated measure of negative parenting, Negative/Ineffective Discipline, than did standard community treatment. The three MTA treatments did not differ significantly from each other on this domain. No differences were noted among the four groups on positive parenting or on family stress variables. Results are discussed in terms of the theoretical and empirically documented importance of negative parenting in the symptoms, comorbidities and long-term outcomes of ADHD.     

Transfer-appropriate processing (TAP)

Transfer-appropriate processing (TAP), as applied to implicit memory, has tended to emphasize general forms of processing (e.g., perceptual or conceptual processing). In the present studies, the TAP principle was employed in a more specific manner in order to more precisely assess the relations between the processing engaged during first exposure and that engaged during second exposure to items. Thirteen experiments used a two-phase, cross-task design in which participants engaged in different combinations of seven specific intentional tasks between Phase 1 and Phase 2. Maximum repetition priming was found when tasks were the same in Phases 1 and 2. When Phase 1 and Phase 2 tasks differed, there were lesser, or no, repetition priming effects, depending on the particular combination of tasks. The results demonstrate the importance of the specific intentional processes engaged during repetition priming and the potential heuristic value of TAP, as a principle and methodology, for exploring the organization of memory and related process models.     

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease

Commentary

Commentary: A Patient's Perspective on Predictive Testing for Alzheimer Disease     

Remembering Alexandra Symonds

The American Journal of Psychoanalysis -     

Infants' understanding of object-directed action

When and in what ways do infants recognize humans as intentional actors? An important aspect of this larger question concerns when infants recognize specific human actions (e.g. a reach) as object-directed (i.e. as acting toward goal-objects). In two studies using a visual habituation technique, 12-month-old infants were tested to assess their recognition that an adult's reach is directed toward its target object. Infants in the experimental condition were habituated to a display in which an actor reached over a wall-like barrier with an arcing arm movement, to pick up a ball. After habituation infants saw two test displays, for which the barrier was removed. In the direct test event the actor reached directly for the ball, the arm tracing a visually new path, but the action consistent with attempting to reach for the object as directly as possible. In the indirect test event the actor traced the old path, reaching over in an arc, even though the wall was no longer present. This arm movement was identical to that in habituation but no longer displayed a reach going directly to its object. In a control condition infants saw the same movements but in a situation with no goal-object. In the experimental conditions, with a goal object present, infants looked longer at the indirect test event in comparison to the direct test event. In the control conditions infants looked equally at both indirect and direct test events. We conclude that sensitivity to human object-directed action is established by 12-month-olds and compare these results to recent findings by [Gergely, G., Nadasdy, Z., Csibra, G., & Biro S. (1995). Taking the intentional stance at 12 months of age. Cognition, 56, 165-193] and [Woodward, A. (1998). Infants selectively encode the goal object of an actor's reach. Cognition, 69, 1-34].     

A mixed-handed advantage in episodic memory: A possible role of interhemispheric interaction

Recent behavioral and brain imaging data indicate that performance on explicit tests of episodic memory is associated with interaction between the left and right cerebral hemispheres, in contrast with the unihemispheric basis for implicit tests of memory. In the present work, individual differences in strength of personal handedness were used as markers for differences in hemispheric communication, with mixed-handers inferred to have increased interhemispheric interaction relative to strong right-handers. In Experiment 1, memory for words was assessed via recall or word fragment completion. In Experiment 2, memory for real-world events was assessed via recall. Results supported the hypothesis, in that mixed-handers displayed better episodic memory in comparison with strong right-handers.